Standard medical ethnobotany of Kohistan, North Pakistan

Background This study was exclusively focused on the documentation and cross-cultural evaluation of ethnomedicinal knowledge (EMK) within the diverse linguistic groups of Kohistan situated between the Himalayan and Hindukush Mountain ranges in the north Pakistan. Methods Data were gathered during the field survey (May 2022 to July 2023) through group conversations, semi-structured interviews, and on-site observation. Venn diagrams were employed to illustrate the comparative assessment of EMK, and different ethnobotanical indices were utilized to examine the data. Results A total of 96 wild medicinal plant species (MPs) belonging to 74 genera and 52 botanical families were documented. The most reported MPs belong to the family Polygonaceae (11 species), followed by Asteraceae (9 species) and Lamiaceae (8 species). The ethnomedicinal uses of Leontopodium himalayanum, Pedicularis oederi, Plocama brevifolia, Polypodium sibiricum, Pteridium esculentum, Sambucus wightiana, Solanum cinereum, Teucrium royleanum, Rhodiola integrifolia, Aconitum chasmanthum were reported for the first time in this region. Among the reported taxa herbaceous species were dominated (72%), followed by trees and shrubs (17% and 10%, respectively). Digestive problems (40 taxa and 114 use reports) and skin disorders (19 taxa and 549 use reports) were the most cited disease categories, whereas M. communis, M. longifolia, Ajuga integrifolia, Ziziphus jujuba, and Clematis grata exhibited the highest percentage fidelity levels. Out of 109 documented medicinal uses, a mere 12 were shared across all linguistic groups, and Bateri emerges as a notable outlier with the highest number of medicinal uses. In addition, a significant homogeneity was noted in the reported botanical taxa (61 species) among different linguistic groups. However, since the last decade biocultural heritage of Kohistan is facing multifaceted risks that need urgent attention. Conclusion Our findings could be valuable addition to the existing stock of ethnomedicinal knowledge and may provide ethnopharmacological basis to novel drug discovery for preexisting and emerging diseases prioritizing detailed phytochemical profiling and the evaluation of bioactive potential.


Introduction
Kohistan region is an important hotspot of biocultural diversity and could be thus declared a biocultural refugium.The region has been a crossroad for the exchange of biocultural knowledge between South, Southwestern Asia, and Central Asia.The close sociocultural interactions among the different ethnic communities within the region and then the invasion of modernization and infrastructural developments pose a clear challenge to local ecological knowledge within each community.In the face of sociocultural as well as environmental change, the local ethnobotanies are changing and in some case the cultural dominancy has driven a change to make the local knowledge blended with exotic knowledge and this phenomenon is well understood in ethnobiology.The multiculturality and multilingualism of the region make the area a viable place to study human-plant interactions.It is worth mentioning that the remoteness of the area has stood out a reason for scientific research in the study area that may have potentially allowed the local communities to retain cultural practices alive and distinct around the local flora.
Our research on food ethnobotany recorded substantial body of local plant knowledge among the different ethnolinguistic groups living across the Kohistan region [1].The current ethnobotanical survey has primarily been guided by our food ethnobotanical research work in the region.Our research has indicated significant level of idiosyncrasy or heterogeneity in local knowledge on food plants among the studied communities and considering these specific patterns of knowledge retention or mobilization within the different groups.We have hypothesized that some important debates especially related to human ecology could be constructed and could come with more concrete results on the pattern of local knowledge mobilization which we might have missed to derive from the results of our previous food ethnobotanical studies.Additionally, it may also give rise to new and more stimulating debate related to context-based social anthropology while discussing the local knowledge systems on medicinal plants within these specific communities.
North Pakistan has been extensively researched in ethnobotanical literature; however, the Kohistan region is still underexplored in the existing literature.The literature indicates specific trends in sharing local plant knowledge among the various ethnic groups.We believe that the medical ethnobotany and its related dynamics are a different subject area then food ethnobotany, and therefore, studies on the medical ethnobotany could provide new insights to enrich the anthropological discussion around the use of local medicinal plants.Moreover, culturally guided uses of plants are an important subject in medical anthropology and therefore the intertwining of medical anthropology and medical ethnobotany plays a pivotal role in understanding the dynamics how the local knowledge systems persist and evolve within modern societies.
In Kohistan, the traditional ecological knowledge including the plant knowledge is highly challenged by the new developing infrastructure that impact the local subsistence and ecological practices, and this in turn has negatively impacted the local knowledge systems.For instance, the ongoing mega projects such as Dassu and Basha Hydropower Projects and several small projects in different valleys of Kohistan are affecting the lifestyle of the young generation significantly.Slowly but surely, allopathic medicines are also integrating with traditional healthcare in this region.Specifically, recent developments under the China-Pakistan Economic Corridor (CPEC) project are one of the key factors diverting the attention of the young generation, thus recording the ethnomedicinal knowledge in Kohistan essential.Specifically, documenting the medical ethnobotany of the region will have a crucial role in understanding how different cultures use plants, and how these uses are guided by social, environmental, and economic factors in shaping human-plant relationship.The aim of the current study is that the medical ethnobotany of the ethnolinguistic groups in Kohistan would provide a holistic view; how human interact with their natural environment?The study will preserve new knowledge on scientific background and will give new directions to the already existing literature as we have seen that many Pakistani ethnobotanical studies have been conducted but lacking the best and standard practices to reach the minimum level of scientific integrity.Our study undertakes clear methodological approach-has been conducted with specific objective to address the proposed research questions.We have documented and compared the ethnomedicinal knowledge on wild medicinal plant species among different linguistic groups of Kohistan region in the north Pakistan.
The specific objectives of the study were: 1. Documentation of the local names and medicinal use of wild plants!2. Cross-cultural analysis and comparison of the quoted plants used in traditional health care system among the different ethnic groups.
by the Indus River (Fig. 1).Characterized by their geographical location, these districts are richly endowed with natural beauty, including majestic mountain vistas, fertile valleys, and vast expanses of biodiversity.Kohistan is distinguished by a dry and cold climate in the winter and a hot and dry climate in the summer.In the valleys, rainfall is prevalent during the winter, while snowfall is observed in alpine pastures and hilly areas [3].
The vegetation of Kohistan falls into dry and moist temperate forests areas [4,5].The primary objective of the present study was to conduct a comprehensive investigation on medicinal uses of wild plant species among different linguistic groups, including Kohistani, Shinaki, Bateri, Pashtoon, and Gujjars, residing in three districts of Kohistan.These linguistic groups, despite their unique dialects and varying lifestyles, do share certain commonalities in religious belief systems and dialect similarities, thus contributing to the diverse cultural mosaic of Kohistan.Additionally, we have discussed in detail the history and ethnolinguistic diversity of Kohistan in our previous article [1].Agriculture, livestock rearing, and weaving constitute the primary economic activities of the inhabitants of Kohistan, significantly contributing to the region's economic vitality [2].Kohistan is the most remote region of Pakistan and lacks modern health facilities.Even in the contemporary era, this region lacks hospitals, necessitating inhabitants to travel over 150 km and endure a journey of at least seven hours to reach the nearest health facility in Abbottabad.Consequently, the inhabitants of this region rely mainly on plants and animals in their environment for sustenance and as components of their indigenous healing practices [6].

Valleys and linguistic groups in Kohistan
The Indus River splits Kohistan into eastern and western parts.Seo, Kandia, and Dubair are three major valleys on the western side, while Jalkot, Palas, and Kolai valleys lie on the eastern side (Fig. 2).In western part of Kohistan, local communities which are known as "Kohiste" speak Kohistani language in different dialects like Shuthun, Maiya, Indus Kohistani, and Abasin Kohistani.The history of Kohistani people and their language is controversial, as different people assume diverse ancestors of Kohistani.It has been documented that Kohistani language belongs to the Dardic group of Indo-Aryan languages [7][8][9][10][11].According to Rensch [7], Kohistani language linking with the Torwali language is spoken in Swat valley.However, there is lack of further details on the origin of Indus Kohistani language.
Local inhabitants in Jalkot, Palas, and Kolai on the eastern side of Kohistan are known as "Shinaki" and they speak Shina language.Shina belongs to the Dardic language family which is a subgroup of the Indo-Aryan linguatuliasis.Phylogenetically, Shina has strong associations with Indo-Aryan, Dravidian, Austro Asiatic, and Tibeto Burman and is written in the "Persio-Arabic script." Some researchers believe that Shina is Brahmi script which was originally used in the era of Ashok in 3rd BC [12].Shina language has different dialects which are spoken in different valleys of Kohistan.It is the most spoken language in different valleys of Gilgit-Baltistan, Jammu and Kashmir, Ladakh regions of Pakistan, India, and China [9,13,14].The different dialects of Shina language, for instance, Kohistani, Astori, Chilasi, Gilgiti, Hunzai, and Diameri, are mainly based on local influence, geography, and topography of valleys [13][14][15].
Bateri, Pushto, and Gujjari linguistic groups are minorities in Kohistan and live in specific areas.Bateri community live in Batera Pain and Batera Bala villages on the east bank of the Indus River in Kolai Pallas Kohistan.Bateri language also known as Bateri Kohistani and Batarwal language belongs to the Dardic language branch of Indo-European family.Beside Kohistan, Bateri is also spoken in Jammu and Kashmir region of India [7].Pushto language belongs to the eastern Iranian language, a subgroup of Aryan linguistics family, and is further divided into Iranian and Indian branches.In Pakistan, the Pushto speaker has different accents and dialects [7,16,17].Although Pushto linguistic group is limited in the Indus Kohistan region, Pashtuns (Pushto speakers) spread almost in all parts of Pakistan, and specifically in the north province "Khyber Pakhtunkhwa." In Indus Kohistan, Pashtuns are common at Shongal and Jag villages in Dubair valley.The nomadic Gujjars live in the most remote area of each valley on both sides of Kohistan.It has been reported that Gujjars came to this region from Mongolia at the time of Mongol incursion on India in the fifth century [10].These tribes speak Gujjari, which accounts for 10.5% compared to other Kohistani and Shina languages [7,8].

Field survey
Twenty study sites/villages were selected to conduct field survey from May 2022 to July 2023.Study sites' selection was based on their ethnicity, linguistic groups, vegetation or forest types, and elevation zones.While conducting the field survey, we meticulously observed the ethical guidelines as recommended by "International Society of Ethnobiology" [18].These guidelines emphasize the importance of maintaining respect for different cultures, acknowledging local knowledge, and preserving biodiversity.Verbal consent of the participants as reported previously [19,20] was taken for data collection, photography, and sharing their knowledge and picture with the public.As demonstrated earlier [21], informants between 20 and 80 years of age were selected using the snowball approach.The study participants chosen for the survey have a long-lasting relationship with the natural environment and the local flora and were recognized as experienced in local medicinal plant knowledge.Male field researchers co-authoring this article recruited male study participants in the interviews (Fig. 3) since female Fig. 3 Authors collecting information during filed survey in different areas of Kohistan informants could not be approached due to cultural/ religious issues; therefore, the first author interviewed only those women who were his relatives.Moreover, it is also important to note that our respondents were not traditional healers or doctors but laypeople, i.e., experts in local plant knowledge who gained it orally from their elders.In the particular social and cultural context of the study area, women participants could be taken for the interviews if they local communities are guided better and explain the purpose of the study with the help of a local guide.
From each linguistic group, 15-20 informants including male and female were selected based on their age, gender, linguistic group, experience, and knowledge (Table 1).In Kohistan, open communication between male and female is strictly restricted, except close family members.With the help of female members or relatives from his family, the first author collected information from female respondents who reside in Kohistan.Data were collected by using field observation, semi-structured interviews, and group discussions as explained earlier [22].The interviews as well as the group discussions were conducted in the local languages (Kohistani, Shina, Bateri, Pushto, and Gujjari).To ensure comprehension, native speakers of these languages and interpreters were engaged.The gathered information was subsequently translated into English, thus facilitating comparative analysis and interpretation.We adopted a mixed approach for selecting the informants.The survey started with participants selected through random sampling, and then, once we became familiar with the study area, we adopted the snowball technique.The duration of the interviews varied, i.e., in some cases, it ended after 20 min, while in others, it lasted for hours.The participants with long experience of nature and who remained in the study area for decades were preferred.Interviews were conducted in public gathering places, local shops, and fields, mainly after prayer near mosques where the local population used to gather and interact.Some people were also interviewed while working in the fields.The information collected from the interviewees focused on the local names of medicinal taxa, parts used, diseases treated, and modes of preparation and application.Free listing was used to obtain a thorough knowledge of the therapeutic uses of the quoted plants.Initial free listing was attempted, but it was usually short and rarely succeeded.

Plant specimen collection and processing
Medicinal plant species enlisted in Table 2, used by the inhabitants of the study area, were collected during the field survey.The plant specimen were identified by expert taxonomists and with the help of Flora of Pakistan [23].Botanical nomenclature and family name of the identified specimen were further confirmed with the help of international data base of plant species "The World Flora Online" https:// www.world flora online.org/.All specimens were properly dried, poisoned, and mounted on herbarium sheets, and the voucher specimens were deposited in the herbarium at COMSATS University Islamabad, Abbottabad Campus, for future records.

Data analysis
Filed data on ethnomedicinal uses of the reported botanical taxa were processed using MS Excel.Furthermore, different ethnobotanical indices, i.e., relative frequency citation (RFC), informant consent factor (ICF), and fidelity level (FL), were also computed.Data were presented in tabulated and graphical format with the help of Sigma Plot v12.Comparative assessment of data among different linguistic groups was presented as Venn diagrams drawn using free software available at http:// bioin forma tics.psb.ugent.be/ webto ols/ Venn/[05 August 2023].To find out novel uses of plant species, a comparison was made between the current ethnobotanical data and previously reported literature from Pakistan and neighboring countries [4,21,, as given in Table 2.

Relative frequency citation (RFC)
The measured value of RFC demonstrates the importance of each plant species among the local inhabitants of an area.RFC is calculated based on the frequency of citation (FC) of each species, which indicates the number of informants citing the use of plant species for a specific purpose.We used the following equation to calculate RFC value of the reported plant species as described earlier [81].
FC indicates the frequency of citation of each species by respondents, and N is the total number of respondents participating in the survey.

Informant consensus factor (ICF)
The informant consensus factor is used to analyze the degree of agreement of the respondents about each use category.ICF of the reported species was computed by using below mentioned formula as reported earlier [81,82].
Nur is the number of use reports in each use category, and Nt is the number of plant species used for that category. (1)

Fidelity level (FL)
The fidelity level specifies ratio among the number of respondents who mentioned use of a plant for a particular purpose and the total number of informants who mentioned the use of the plants for any purpose regardless of any use category.The FL values ≈ 100% are obtained for plants having almost all use-mentions refer to same purpose, whereas low FL is obtained for the plant species that have multipurpose uses [83,84].The fidelity level of the reported species was calculated using the formula as given here: Ip is the number of respondents who reported the use of a plant species for a specific purpose, and Iu is the total number of respondents who mentioned that plant species for any purpose.

Features of the targeted localities and respondents
Data were meticulously gathered for the current ethnomedical study from 20 villages dispersed across five distinct valleys in the captivating Kohistan region: Seo, Jalkot, Kandia, Kolai, and Dubair (Table 1).The survey spanned an altitudinal range from 625 m above sea level (m.a.s.l.) in Bateri pine village to 4741 m.a.s.l. in Gotay Baig village.The vegetation cover in the surveyed area exhibited a spectrum from dry temperate to moist temperate, and subalpine to alpine pastures, mirroring the altitudinal variations.Kohistan's entire population adheres to Sunni Muslims, with historical records indicating their settlement in the region from the sixteenth to seventeenth century and conversion to Islam occurred during the eighteenth century.According to Fredrik Bart (1956), the Chinese Pilgrims traveled through the Indus Kohistan region.Although the Chinese pilgrim reported about the difficult trains of the routes, it did not mention about the inhabitants of Kohistani [10,85].Notably, the Kohistani people differentiate themselves in terms of ethnicity, language, and culture from neighboring populations in the Swat, Dir, Gilgit, and Baltistan regions of Pakistan.Their beliefs underscore distinctions between both Pashtun and other local communities in Gilgit-Baltistan.Most of the local population in Kohistan faces literacy challenges and is engaging in subsistence activities such as pastoralism, animal husbandry, farming, and mining.
In the present study, data were collected from 281 informants of 20-80 years of age.Ethnically, these informants were classified into distinct groups, including Seowos, Gujjars, Shinaki, Jalkoti, Kheloos, Kulooj, Bahtooj, Shongali, ( 3) Jaagi, and Dubairi.These groups communicate primarily in the Kohistani, Shina, Gujjari, Bateri, and Pushto languages.Each linguistic group exhibits a unique culture and predominantly resides in different valleys, except for the Gujjars, who are dispersed across all valleys.Most of these linguistic or ethnic groups practice endogamy, with rare instances of exogamy, except for the Gujjars and Bateri, who engage in exogamous relationships with other ethnic groups.Unfortunately, the latter two groups often experience marginalization within the Kohistan region.This intricate social fabric reflects the diversity and historical evolution of the Kohistani people.

Diversity of wild medicinal plant species
The wild medicinal plant species (WMPs) have played a significant role in the mountain communities' healthcare practices for centuries and continue to do so today.The utilization of WMPs has been a longstanding tradition in the healthcare practices of the Kohistan region.This emphasizes the reliance of the mountain communities in this region on various plant species to meet their healthcare needs.Specifically, the WMPs play a crucial role in the local healthcare practices and are considered an integral part of the traditional medicine system of Kohistan.
According to the data presented in Table 2, the inhabitants of Kohistan use 96 WMPs, which belong to 74 distinct genera and 52 botanical families.Among the botanical families, Polygonaceae was the most prevalent, comprising 11 WMPs, followed closely by Asteraceae, Lamiaceae, Solanaceae, and Rosaceae, each contributing 10, 8, 5, and 4 WMPs, respectively.The extensive use of WMPs from the Polygonaceae family can be attributed to their diverse medicinal properties, such as antiinflammatory, wound-healing, and antibacterial potential that make them effective in treating a wide range of ailments [86].Interestingly, our findings align with previous studies conducted in the northern parts of Pakistan [22,87].These studies have also reported the dominance of Polygonaceae and Lamiaceae families in the Gilgit-Baltistan region, Kohistan, and surrounding areas is due to their widespread ecological distribution [60,88,89].
As depicted in Fig. 4A, the reported WMPs consist most of herbs (71.8%), followed by trees (16.6%) and shrubs (10.4%).These findings align with the geographical features of the Kohistan region, which predominantly consists of expansive pasture lands adorned with a variety of lush green herbs.Additionally, the local inhabitants of Kohistan exhibit a preference for collecting and utilizing herbaceous WMPs from their surroundings due to their accessibility and numerous health benefits, as compared to trees and shrubs.This observation corresponds to previous studies conducted in the other areas of Kohistan [79,89].

Part(s) used, modes of preparation and application
The inhabitants of Kohistan use different parts of the reported WMPs to treat various ailments (Fig. 4B).Among these, aerial parts of 36 herbaceous plant species are used in traditional therapies, followed by leaves of 28 species, fruits and roots of 18 species each, branches of 8 species, and stem of 5 species, whereas bark, seeds, rind, flowers, and resin of less than 5 WMPs are used in the primary health care system of Kohistan.Among these, leaves are the most utilized plant parts in traditional remedies for treating various diseases.
The use preference of leaves in traditional therapies could be attributed to their ease of collection compared to other parts of WMPs.Moreover, numerous studies have highlighted that leaves contain a rich concentration of secondary metabolites like polyphenolics, alkaloids, carotenoids, and vitamins, which have significant antimicrobial, antioxidant, anti-inflammatory, and other bioactive properties [89,90].Furthermore, the use of leaves instead of roots, flowers, seeds, and fruits in traditional medicines represents a more sustainable conservation approach that minimizes the risk of depleting valuable medicinal plant species [35].
The array of methods employed in the preparation of herbal remedies includes everything from sun drying and grinding with mortars and pestles, to fermentation, distillation, and maceration, each having its unique advantages.As illustrated in Fig. 5A, local inhabitants of the study area utilize a total of eight different methods for preparing herbal remedies.Most of the reported WMPs (49 species) are shade dried and grinded using a mortar and pestle to make a fine powder that can be taken orally or applied topically to treat various diseases.According to the local respondents, the powdered crude drugs can be stored for extended periods of time in cotton sacks or pots made from mud or silver.Additionally, fresh plant parts (consisting of 19 species), pastes (13 species), decoctions (12 species), and extracts (10 species) are commonly employed modes of preparation in traditional recipes for the treatment of various ailments.These traditional recipes have their own unique preparations and applications.For instance, fresh leaf decoctions are commonly used as cleansing agents, while pastes made from powdered roots are often applied topically to treat skin infections.
Among these recipes, approximately 72% (Fig. 5B) are taken orally in the form of decoctions, infusions, or extracts, while 25.8% are applied topically as pastes, powders, or oils, particularly for addressing skin infections.Water, milk, diluted curd (lassi), ghee, and butter are frequently used as mediums for consuming the powdered or fresh parts of wild medicinal plants.It is worth noting that similar methods of preparation and administration have been reported in previous studies conducted in this region, and neighboring areas [31,32,34,57,60,67,77,[91][92][93][94].
In accordance with the guidelines outlined by the international classification of primary care ICPC-2 [95], the recorded ailments among the inhabitants of Kohistan were classified into twelve distinct categories (Table 3).These include general and unspecified diseases (OTHA-A), digestive disorders (GAS-D), cardiovascular problems (CAR-K), conditions related to blood, bloodforming organs, and the immune system (Blood-B), musculoskeletal disorders (SKE-L), neurological disorders (NER-N), respiratory infections (RES-R), skin diseases (DER-S), urological disorders (URO-U), cancer (CAN-C), pregnancies, childbirth, family planning (PRE-W).For diseases that did not neatly fit into any specific category, minor modifications were made.Examples of such cases include fever, allergies, back pain, typhoid, and spiritual uses-these were categorized as general and unspecified.

Quantitative analysis of the reported WMPs
In total 281, respondents of five linguistic groups reported medicinal uses of 96 wild plant species, and total use reports were 3298 (Table 2).Among the reported botanical taxa, Myrtus communis had the highest RFC (0.34).This medicinal plant species is evergreen and local inhabitants of Kohistan use its leaves to treat eczema.In addition, M. communis is also used as tea, and flavoring agent in traditional cuisines of Kohistan (Amin et al. [1]) and has been reported as a medicinal plant in the neighboring regions [96,97].Beside this, Sambucus wightiana, Punica granatum, Quercus semecarpifolia, Astragalus anisacanthus, Persicaria capitata, Polygonum aviculare, and Polypodium sibiricum had maximum RFC.
The Informant Consent Factor (ICF) specifies consistency of understanding among respondents regarding ethnomedicinal application of specific plant species to cure diseases.The ICF values range from 0 to 1, and a disease category with highest ICF value exhibits maximum consensus of the respondents [98].The ICF values for various disease categories as mentioned in Table 3 were calculated based on ethnomedicinal information provided by the respondents of different linguistic groups of Kohistan.The ICF values of reported disease categories ranged from 0.65 to 1.The highest number of WMPs were reported against GAS-D disease category, followed by DER-S, OTH, RES-R and OTHA-A (ranged from 13 to 40 botanical species).On the other hand, less than 10 species were documented for the remaining disease categories.Likewise, based on use reports major disease categories were in following order: DER 3).These findings provide valuable insights into the ethnomedicinal practices within different linguistic groups of Kohistan and highlight which diseases have received more attention in terms of herbal remedies.Overall, findings of this study demonstrate the consistency and agreement among respondents regarding the traditional therapeutic uses of specific plant species for various diseases.The results shed light on potential sources for further exploration and development in ethnobotanical research.
Although the NER-N, CAN-C, and PRE-W disease categories showed the highest ICF values (1 for each category), there was a noticeable lack of WMPs usage (1 species for each disease category) and minimal use reports (26 use reports for each disease category).This could be due to the rarity of neurological disorders (NER-N) and cancer (CAN-C) in the study area or a lack of awareness among the local population about these diseases.In the Kohistan region, neurological disorders such as epilepsy, stroke, and trauma are relatively uncommon.Similarly, cancer is also rare, which could be attributed to under-diagnosis or under-reporting.However, it is important to note that certain regions have a high incidence rate of neurological disorders like epilepsy, while globally there is an increasing trend in cancer cases.Even in developed countries, neurological disorders and cancers contribute significantly to morbidity rates.The difference in reported usage might be attributed to limited accessibility or availability of WMPs, cultural taboos, or a lack of recognition by local healers.Nonetheless, it is worth mentioning that despite being the less common ailments in this region, both CAN-C and PRE-W disease categories still showed high ICF values which indicate the perceived utility of WMPs in this region.
While digestive problems (GAS-D), skin diseases (DER-S), and respiratory system disorders (RES-R) have lower ICF values, they still hold significance in the study area.This is evident from the utilization of a high number of botanical taxa for the treatment of these diseases.For instance, 40 WMPs are used to treat digestive problems, 19 species to cure skin diseases, and 17 species for treating respiratory system disorders (Table 2).The largest number of botanical taxa against the above-mentioned diseases revealed prevalence of such heath disorders in the study area, and acceptability of WMPs among different linguistic groups of Kohistan.Our findings align with previous studies [99][100][101][102], reporting digestive disorders and skin infections as common health issues in high mountain regions.Similarly, the harsh climatic conditions, high altitude, exposure to UV radiation, and unhygienic practices at both individual and community levels may contribute to the prevalence of these diseases in Kohistan.
Female health issues, particularly during pregnancy and childbirth (PRE-W), are most prevalent in Kohistan.However, due to cultural barriers, collecting information on these diseases is challenging.In certain societies like Kohistani communities, there is a cultural taboo associated with discussing women's health problems, making it even more difficult to gather data.These practices hinder our understanding of the true extent of female health issues in this region.Additionally, family planning issues are not common as having more children is preferred in Kohistan.Therefore, it is essential to address these challenges and find ways to gather accurate information on female health issues in this region.And that can be only possible by the active participation of female researchers from Kohistan and its allied areas.By doing so, we can develop effective interventions and provide appropriate healthcare services to improve the well-being of women in the Kohistan region.
According to Chen et al. [98], the fidelity level (FL) is an important measure for determining the effectiveness of a medicinal plant species in treating specific diseases compared to other plants used for the same purpose.High fidelity levels indicate that a particular plant species is consistently used by many individuals to treat a particular disease [102].In our study, we found that 12 WMPs had fidelity levels ranging from 41.67% to 94.44%, demonstrating their significant medical applications within different linguistic groups of Kohistan (Table 3).The highest fidelity level of 94.44% was observed for Myrtus communis in treating skin diseases, specifically eczema, followed by Mentha longifolia with a fidelity level of 92.86% (Fig. 6), commonly used for digestive disorders such as diarrhea and indigestion (GAS-D).Interestingly, this finding aligns with Ahmad et al. [103] report on local communities in Madyan valley, Swat Pakistan, where similar species was utilized against gastrointestinal disorders.While it appears that M. communis has not been previously documented for its effectiveness in skin diseases.However, Haq [69] reported that inhabitants of Allai valley in the western Himalayan region of Pakistan use the same species to alleviate bronchial congestion.Likewise, Ajuga integrifolia, Ziziphus jujuba, Clematis grata, Lepidium sativum, Artemisia brevifolia, Verbascum thapsus, and Datisca cannabina have shown fidelity levels of ≥ 60% against various diseases (Table 3).The inhabitants of Kohistan utilize the leaves of A. integrifolia to alleviate fever, skin infections, and purify blood.Conversely, Ozturk et al. [24] stated that the same plant species is used to address hypertension in different regions of Turkey, Pakistan, and Malaysia.Similarly, Muhammad et al. [104] have reported a fidelity level of 100% for Z. jujuba from Malakand division KP, Pakistan in relation to lactation support and the treatment of skin disorders, gastrointestinal issues, urological conditions respiratory ailments diabetes and insomnia.
Conversely, the local population in Kohistan employ powdered seeds from Z. jujuba to manage blood pressure levels and promote blood purification.Leaf powder from Clematis grata is orally administered for the treatment of urological disorders, but Rehman et al. [32] have highlighted that same species is used among tribal communities in the Buner region of Pakistan for managing skin infections.The efficacy of decoctions made from L. sativum leaves against asthma aligns with reports by Alamgeer et al. [50].Inhabitants of Kohistan frequently utilize leaf powder derived from A. artemisiifolia as an anti-rodent and mosquito repellent, and its fidelity level is 64.29%.It should be noted that this utilization contradicted to the findings of Zhao et al. [25] who classify A. artemisiifolia as an invasive weed that poses harm to crops in Europe and Asia.Moreover, this species is also known to produce copious amounts of allergenic pollen grains that can adversely affect human health [105].The fidelity level of V. thapsus in alleviating labor pain and respiratory disorders was found to be 58.33%,while D. cannabina demonstrated has FL 57.14% in reducing joint swelling.It is worth noting that Khan et al. [3] have documented the use of V. thapsus leaves for treating asthma and skin infections among the residents of Kashmir Himalayas, Pakistan.However, the application of this plant species against labor pain remains relatively unexplored in existing local and regional literature.Based on the high FL, we recommend further pharmacological investigations on these WMPs to explore their potential benefits and mechanisms of action.

Cross-culture analysis on the use of the botanical taxa
The cross-cultural analysis conducted among the five linguistic groups in Kohistan has unveiled a notable level of heterogeneity on the medical ethnobotany of the studied groups.Considering the number of plant taxa, the quoted botanical taxa among different linguistic groups are illustrated in Fig. 7.A total of 61 plant taxa (63%) were found to be commonly shared across all groups for the treatment of various health The complex web of medicinal uses of the commonly used plants among the various groups is shown in Fig. 8. Venn diagram elucidates the intricate tapestry of medicinal plant utilization within these linguistic communities.Out of the total 109 documented medicinal uses, approximately 1.83% of the quoted uses were found to be shared across all linguistic groups.We have observed that 12.84% of the uses do overlap among the plant uses of Kohistani, Shina, and Gujjari.It is also important that close affinities (36 uses commonly along 33.02%) on the uses lie between Shina and Kohistani and this may be due their cultural and social dominancy and their social interactions might lead them to share and retain knowledge.
Most of the communal land is owned by these two groups in Kohistan and therefore is evident that these have been the original inhabitants of the study area for generations.The Kohistani and Shinaki people have shared sufficient idiosyncratic uses of plant species, while Bateri also emerged along with them.The Bateri linguistic group who claim to be autochthonous to the study area have some interactions with Kohistani, and we have observed the names of some plants who shared them with Shina although the fact is that their language is branch of Kohistani languages.Despite claiming indigenous roots in Kohistan, the Bateri population has diminish gradually in size over time and now only concentrated in the Bateri village, nestled within the Himalayan expanse of Kohistan-an area.Although Bateri is a linguistic minority in Kohistan, the distinctive wealth of traditional knowledge on idiosyncratic medicinal uses of wild plant species among them can be attributed to their ancestral knowledge, strong association with traditional health care system, historical marginalization, and to some extent due to intermarriage with Kohistani and Shinaki communities.
Within the broader context of Kohistan, Shina speakers (Shinaki) and Kohistani constitute the predominant linguistic groups, collectively spanning almost 80% of the region.The Shinaki groups assert dominance in the Himalayan regions, while the Kohistani communities prevail along the Hindu Kush Mountain range, flanking the right and left banks of the Indus River, respectively.Despite the abundant diversity of medicinal plants in both mountainous terrains, the Kohistani and Shina groups reported relatively fewer medicinal uses, documenting 27 and 26, respectively.As reported earlier [106,107], discernible impact of modernization, encapsulating factors such as enhanced education, migration, and urbanization, is evident within Kohistan, and Shina linguistic groups is leading to a discernible decline in traditional knowledge.Adding a layer of complexity, the migratory patterns of the Shinaki people of Jalkot and allied areas offer insights into their traditional knowledge.During the summer, these communities typically migrate toward subalpine and alpine pastures where the above-mentioned botanical taxa are commonly found.As a result, the Shinaki people possess an intimate understanding of the medical applications of these unique plant species prevalent in the alpine and subalpine regions.The Pushton and Gujjari communities, often perceived as non-native in Kohistan, are confined to specific geographical areas.The Gujjari people, primarily nomadic, exhibit a preference for alpine and subalpine valleys and pastures.In contrast, a limited population of Pushto speakers resides in the lower regions of Kohistan along the River Indus.This limited dissemination of traditional knowledge is attributed to the tendency of Gujjari community to preserve such knowledge within the confines of their own family circles.The exploration of plant resource utilization among diverse ethnolinguistic groups unveils a fascinating tapestry of both homogeneity and heterogeneity [1,[108][109][110].

Novelty in reported WMPs
Comparative assessment of ethnomedicinal uses reported by different linguistic groups of Kohistan (as shown in for the first time (Fig. 9).In addition, although Artemisia stechmanniana, Cirsium verutum, Rubus niveus, Rumex abyssinicus, and Silene conoidea, are used in traditional health care systems of China, Nepal, Bangladesh, Ethiopia, and India [27,36,66,68,71], they never have been reported as medicinal plant species in Pakistan.Likewise, there were significant variations in plant part(s) used, mode of preparation, application, and types of diseases treated of the commonly reported medicinal plant species.For instance, the aerial parts of Primula elliptica and P. macrophylla are used in snuff by the inhabitants of Kohistan, but roots and flowers of the same species are used to heal wounds and against jaundice in Swat, Pakistan [61].Likewise, inhabitants of Kohistan use seeds of Ziziphus jujuba as blood purifier; however, fruits and roots of same species were reported to treat diabetes and obesity [53,79].

Threats to ethnomedicinal knowledge of Kohistan
Ethnomedicinal knowledge among various linguistic groups reflects their beliefs, cultural practices, and bioresource management experience [111].This knowledge, especially among minor groups in mountain regions like northern parts of Pakistan, is at risk of erosion due to challenges like globalization and urbanization [13,99].
Our research found that the Bateri, a minor group, has significant botanical knowledge for public health, but it is fading due to younger generations' disinterest and influence from dominant groups like Shina and Kohistani.This loss threatens traditional ethnomedicinal knowledge from this region.In Kohistan, mega projects like the Dassu and Diamar Bhasha dams are changing lifestyles, leading to cultural erosion and loss of indigenous knowledge.It has also been seen that people migrate to other areas and the economic situation among many households is in transition.Because of this Kohistani people are losing connection to their local natural resources that in turn impact the core body of knowledge and its intergenerational transmission.Young people relocating for better job opportunities further disconnect them from their traditional roots.One of the most important things is that Shina and Kohistani who are the dominant groups in the study area are somehow going through the economic transition as the developmental infrastructures are affecting the localities of the two groups.Therefore, their plant knowledge transmission is more threatened than other groups.Overall, the practical use of local medicinal plants is sufficiently practiced as compared to other parts of the surrounding areas [21,60,88,109,112].
The absence of written documentation and inclusion in educational curricula exacerbates this loss.We can also use this to make people aware of the importance of natural resources, brochures should be periodically circulated.These brochures should be properly designed, and the relevant ethnobotanical knowledge should be the main material included in that.These brochures should be part of workshops that address the conservation of local flora in schools and colleges in the study area.Thus, preserving this knowledge requires a holistic approach involving government and educational authorities, focusing on conservation, natural resource management, and incorporating traditional knowledge into local education [99].Moreover, engaging local communities and religious schools in Kohistan is crucial for the success of these conservation efforts, as these communities highly regard instructions from religious leaders.Cultural activities and educational programs can also aid in preserving this knowledge.basis for novel drug discovery and therapeutic opportunities for preexisting and emerging diseases.In the present study, a compelling observation of significant homogeneity emerged in the reported botanical taxa among different linguistic groups, and ≥ 63% of the plant species, possessing diverse therapeutic properties, were commonly employed across all groups for the treatment of various health disorders.Surprisingly, the Bateri linguistic group (a minority) emerges as a notable outlier, detailing the highest number of medicinal uses of the reported botanical taxa, and the distinctive wealth of traditional knowledge on idiosyncratic medicinal uses of wild plant species among them can be attributed to their ancestral knowledge, strong association with traditional health care system, historical marginalization, and to some extent due to intermarriage with Kohistani and Shinaki communities.Our findings revealed that in the era of modernization, Kohistan still holds a unique biocultural diversity thus proving our hypothesis on rich floristic and cultural diversity of Kohistan and significant ethnomedicinal knowledge of its inhabitants.However, changing live style, shifting socio-economic circumstances, cross-cultural interactions, migration due to remoteness, dominance of major linguistic groups, oral transmission, and lack of proper documented ethnomedicinal knowledge, and ignorance of government and local authorities are multifaceted risks to traditional knowledge and biocultural heritage of Kohistan.In this context, public awareness and education of young generation by the active involvement of education systems "formal and religious" may contribute significantly to the protection, and conservation of biocultural diversity, and ethnolinguistic knowledge in Kohistan.Women in the mountain regions are main custodians of ethnomedicinal knowledge and hence must be given priority in future studies in Kohistan region.Furthermore, phytochemical composition and pharmacological studies should consider wild medicinal plant species of Kohistan having highest RFC, ICF, and FL values.

Fig. 1
Fig. 1 Map illustrating study area and survey sites

Fig. 2
Fig. 2 Panoramic view of different valleys in Kohistan

Fig. 4 AFig. 5 A
Fig. 4 A Different life forms B part(s) used of the reported WMPs

Fig. 7
Fig. 7 Medicinal plant taxa reported by all linguistic groups Fig. 8 Comparison of medicinal uses mentioned by different linguistic groups

Table 1
Characteristics of the targeted localities and study participantsAH arrival history in the area, SA subsistence activities, EnR endogamic rules, ExR exogamic rules, El elevation, NH number of households, NI number of informants, M male, F female, AG age groups, NR

Table 2
Ethnomedicinal application of wild plants of Kohistan

Table 2
(continued) K kohistani, S shina, B bateri, P pushto, G gujjari, PRTU previously reported as ethnobotanical use, PRMP previously reported as a medicinal plant, FC frequency of citation, RFC relative frequency of citation, UV used value, Ap aerial part, Lvs leaves, Rt roots, Stm stem, Fl flower, Fr fruit, Sd seed, Brk bark, Rn resin, Rnd rind

Table 3
Diseases category, informant consent factor, and fidelity level of the reported WMPsNbt number of botanical taxa used, NUR number of use reports, PS prefer species, FC frequency of citation, UM use mention, FL fidelity level S.